Recently there has been a great deal of publicity about research done by Dr. Yoshitsugi Hokama, Professor in the Department of Pathology at the John A. Burns School of Medicine at the University of Hawaii at Manoa, which was sponsored by the National CFIDS Foundation. In a press release by the Foundation, it was claimed (1), "The research, for the first time, discovered ciguatoxin, a potent neurotoxin, in the blood of Chronic Fatigue Syndrome patients." What is ciguatera poisoning and is this really the result that Dr. Hokama found?

The press release stated, "Ciguatoxins are potent, heat stabile, non-protein, lipophilic sodium channel activator toxins and are recognized as some of the most potent biological toxins known. They produce dramatic neurological manifestations, such as peripheral sensory or motor symptoms (including paresthesias, pain, burning, tingling, numbness), central symptoms such as headache, autonomic dysfunction and also affect multiple body systems (gastrointestinal, immune, hepatic, cardiovascular) and the muscles." The press release went on to say, "Many CFS patients in the study had higher levels of the toxin than the patients with cancer, hepatitis or acute ciguatera poisoning. Quantitative assay results range from 1:5, the lowest toxin level, to 1:160, the highest toxin level. All CFS samples gave titres of at least 1:20, with the majority of titres from 1:40 to 1:160."

Is it believable that the typical Chronic Fatigue and Immune Dysfunction Syndrome/Myalgic Encephalopathy (CFIDS/ME) patient actually has ciguatera poisoning? Well, no. There may be some misidentified CFIDS/ME cases that are ciguatera cases in Hawaii, Australia, Florida and other places where ocean fish such as barracuda that are found off coral reefs are eaten regularly, but such fish are not in a typical person's diet. The only way one can get ciguatera poisoning is by ingesting the toxin, and the toxin is only occasionally found in such fish, which are the top of the food chain. There is no other source. The typical human being will never be exposed to ciguatoxin.

But did Dr. Hokama actually claim that all the CFIDS/ME patients in his study (as well as the cancer and other patients) actually had ciguatoxin in the blood stream? No, again. The title of his presentation at the International Symposium on Toxins and Natural Products in Okinawa, Japan makes that clear. His talk was, "Acute phase lipids in sera of various diseases: chronic fatigue syndrome, ciguatera, hepatitis, and various cancer with antigenic epitope resembling ciguatoxin as determined with Mab-CTX." The key words are "acute phase lipids" and "antigenic epitope resembling ciguatoxin." Apparently Dr. Hokama developed the Membrane Immunobead Assay test for patient sera, using a specific monoclonal antibody for ciguatera toxin (Mab-CTX). From the abstract of his talk, it is clear that what Dr. Hokama found was that his antibody bound to a lipid substance or substances in the blood. Antibodies cross-react and can bind to multiple substances. Anyone with allergies has unfortunately often discovered that fact. So the substance or substances (they might differ in different people) to which the antibody bound might not be ciguatoxin. In fact it is highly likely that the substance wasn't ciguatoxin. He suggests it is some type of lipid released by the liver.

So what was it and what is the significance of the findings? Both are unknown at this time. Certainly Dr. Hokama's research is very interesting. Are the substances the antibody bound to in sera the same in each subject? Are the lipid substance or substances bound also toxins or containing toxins? I hope he does more specific research to find out. Ciguatoxin has anticholinesterase activity. So it interferes with the breakdown of acetylcholine. Perhaps the mystery substances bound by the antibody do as well, which would explain some symptoms in some CFIDS/ME patients.

So should CFIDS/ME patients rush out and get Dr. Hokama's testing for ciguatoxin that the National CFIDS Foundation has advertised? No, since no useful purpose would be served. Even if the test was precisely specific only for ciguatoxin, no treatment for ciguatera poisoning is known. Further, it is quite clear that this antibody test is definitely not specific for ciguatoxin. We don't know what the other substances are that the antibody binds to, nor if they are even toxins. So save your money and wait for further research. I wish I could say that Dr. Hokama's findings are a major breakthrough in understanding CFIDS/ME, cancer, hepatitis and cardiovascular disease, but at this stage they clearly aren't. But they are interesting. I hope Dr. Hokama looks more closely at the chemical structures to which his antibody will bind and researches the significance of these lipid substances he's already found with that property.

1. "Neurotoxin Discovered in Chronic Fatigue Syndrome," National CFIDS Foundation, published on CO-CURE, November 17, 2002.